Literature Collection

AIM: To determine the association between types of mental illness, levels of social disadvantage and metabolic risk factors (obesity, tobacco smoking, high blood pressure and high cholesterol) and to investigate whether mental health care plans modify metabolic risk. METHODS: Two cohorts (2016-2023) of all primary care patients in Western Sydney with active mental illness or never having a mental illness (reference cohort) were compared on metabolic risk and change in metabolic risk during the period of the care plan (12 months) using random effects regression. Also, the social gradient of metabolic risk in patients with active mental illness was determined. Analyses were adjusted for age, sex and social disadvantage. RESULTS: There were 29,592 patients with active mental illness and 962,416 never having mental illness. Care plan utilisation ranged from 35% to 51%, with the lowest utilisation for Schizophrenia (33%). Daily tobacco smoking rates were elevated for all mental illness types. Care plans were associated with a reduction in daily tobacco smoking rates (0.7 odds ratio; 95% confidence interval: 0.6-0.99). Patients with schizophrenia had excess body mass index (+5.6 body mass index; 95% confidence interval: 2.1-9.1). Care plans reduced the excess body mass index (-6.6 body mass index; 95% confidence interval: -17.7 to +4.5)). Obesity and daily tobacco smoking followed a social gradient in patients with mental illness, but cholesterol and blood pressure did not. High blood pressure and high cholesterol was not elevated compared to the reference group in all types of mental illness. CONCLUSION: Metabolic risk was particularly elevated in tobacco smoking rates for patients with any active mental illness and for obesity in patients with schizophrenia. Care plans were associated with a reduction in much of this risk.

The rising prevalence of mental health conditions and substance use disorders (MH/SUD) underscores the important role of health centers (HCs) in caring for low-income and uninsured MH/SUD patients. This study used the 2014 Health Center Patient Survey and 2014 Uniform Data System to determine the independent association between delivery of MH/SUD integration and related interventions to patients that reported a MH/SUD condition (n=2714) with the number of HC visits, emergency department (ED) visits, and hospitalizations last year. Results showed that health education was associated with fewer predicted ED visits (1.8 vs. 2.3) and lower likelihood of hospitalizations (16% vs. 24%) among MH patients. Medical enabling services was associated with lower rates of ED visits (0.3 vs.1.9) and hospitalizations (< 1% vs. 13%) among SUD patients. The results indicate the utility of integration and related intervention services in primary care settings to improve service use and reduce ED and hospitalization among MH/SUD patients.